Oncology Data Advisor: Hi everybody, welcome to Oncology Data Advisor. Today we're having a faculty panel discussion in advance of our ODACon Supportive Care Summit, a virtual conference which is going to be held on Saturday, November 12th. I'm joined by our four expert nurse faculty for ODACon: our chairperson, Dr. Constance Visovsky from the University of South Florida; Julia LaBarbera, who is a Nurse Practitioner at the University of California Los Angeles (UCLA) Health; Abbey Kaler, who is an Advanced Practice Registered Nurse at MD Anderson; and Janie Metsker, who is a Clinical Coordinator at St. Luke's Hospital.

Today they're going to be giving a preview of the topics that they'll be discussing at ODACon, as well as highlighting some of their individual research interests. Thank you all again for joining us today. Would you like to go around and introduce yourselves? Dr. Visovsky, if you'd like to start off?

Constance Visovsky, PhD, RN, ACNP, FAAN: Sure, I'm Constance Visovsky. I'm a Professor and the Endowed Chair of Nursing Science at the University of South Florida in Tampa, Florida.My research interest is in cancer symptom management and behavioral interventions.

Oncology Data Advisor: Great, Julia, if you'd like to introduce yourself?

Julia LaBarbera, MSN, RN, AGACNP-BC: Sure, I'm a Nurse Practitioner. I work for UCLA at a community office in Santa Monica. Our focus is primarily breast cancer. I've been in oncology for over 15 years, so it's very near and dear to my heart. We are currently doing a lot of clinical trials, both in the metastatic and early breast cancer space, but I have a personal clinical interest in survivorship.

Oncology Data Advisor: And Abbey?

Abbey Kaler, MS, APRN, FNP-C: Hi everyone, my name is Abbey Kaler and I am a Nurse Practitioner at MD Anderson Cancer Center in Houston, Texas. I lead the Advanced Breast Cancer Program. I'm excited for ODACon because I'll be giving presentations about monoclonal antibodies and human epidermal growth factor receptor 2 (HER2) tyrosine kinase inhibitors. In celebrating Metastatic Breast Cancer Day yesterday, October 13th, I was really honored to have the publication of my concept analysis of the patient voice and patients living with metastatic cancers. It's really looking at how we can use the patient's voice to positively impact their care and ultimately their quality of life.

Oncology Data Advisor: And Janie?

Janie Metsker, RN, BSN, CN-BN: I want to say congratulations to Abbey first, and also to introduce myself. I am Janie Metsker. I am the Clinical Coordinator at the St. Luke's Center for Advanced Breast Cancer in Kansas City with St. Luke's Hospital, and I am also the Breast Center Nurse Navigator there. I also have a personal interest in breast cancer and survivorship. I will be presenting at the ODACon conference in November about poly (ADP) ribose polymerase (PARP) inhibitors and PI3K treatment. I'm looking forward to that and to meeting with all of you.

Oncology Data Advisor: We're excited to talk to you all today and for ODACon in November. Connie, if you'd like to start off, maybe you could tell us a little bit about your research in chemotherapy-induced peripheral neuropathy (CIPN)?

Dr. Visovsky: Sure, so I didn't mention earlier that I also am a Nurse Practitioner and I've been a Breast Nurse Practitioner for many, many years. I'm currently not practicing now because I'm really focused on teaching and research here at the University, but I also have a great interest in metastatic breast cancer and symptom management. While my own research is focused on chemotherapy-induced peripheral neuropathy, I'm interested in all kinds of symptom management.

As we'll discuss in the conference, with these novel therapies for breast cancer, we have to realize that there is so much we don't know. We may know now some of the acute toxicities that people experience like diarrhea or liver toxicity, or things like that. But what we don't know are the long-term toxicities that people might be living with eventually, but we just don't know about at this time, that would respond to more research.

My training, once I finished my PhD in post-doctoral work, was in exercise behavior. I'm currently running a clinical trial that's funded by the National Cancer Institute. It's a $2.2 million grant to use gait and balance and resistive exercises to ameliorate chemotherapy-induced neuropathy in women who've had taxane-induced neuropathy that's persistent. In other words, whether you finished six months ago or you finished five years ago, you can still have neuropathy symptoms. So far, we've enrolled about 70 women in the study. It's ongoing. We ask questions about their neuropathy symptoms and quality of life. We do very sophisticated measures of gait and balance and muscle strength, nerve conduction testing, and even nerve biopsy to investigate the correlation between the nerve conduction test and the intra-epidermal nerve fiber density. So, stay tuned. That's my area of research.

I'm excited for this conference. I recommend all oncology nurses to attend this because you will find a great deal of information specifically for nursing that you won't find in other conferences about these novel therapies. Thank you.

Oncology Data Advisor: Thank you so much. Janie, moving on to you, would you like to share a little bit about what you'll be talking about at ODACon, as well as your research?

Ms. Metsker: Just to echo what Connie said, this is a conference that is focused on these novel therapies, because as more and more of them are now FDA-approved and commercially available, the indications and the side effects of dealing with those—especially in women with metastatic breast cancer—is really an important point for nurses and physicians as well. Keeping up with the new therapies that are available, being able to manage them in the clinic and when the patient calls and having that expertise and that knowledge when patients are on these different medications, are all so important.

I work at the Koontz Center in Kansas City. We treat only metastatic breast cancer in that clinic. We have a specialist who has really carved that out as a specialty field for metastatic breast cancer alone, and we really do focus on the things related to quality of life as well. When patients come in for the very first visit, we have them see the physical therapist, the dietician, and our psychologist to address some of those issues upfront that Connie mentioned. I'm very interested in her research on how exercise impacts these toxicities that women deal with. They're so unique in how they affect each and every person, so we really have to be able to give them the support that they need.

One of the things that I wanted to mention with our clinic is, as the Koontz Center was opening in 2016, one of my passions was the metastatic breast cancer retreats. It's the work of Lillie Shockney at Johns Hopkins that she had done for many years and initiated. There was a toolkit available for people to use and develop that retreat for their own site. It took a year, and that was my personal project. I loved it, and it's the most rewarding thing I've ever done in nursing. I do love the retreats and what they do for people. We actually did some research around those retreats. I know that the National Breast Cancer Foundation is one of the sponsors of this event. They have been very supportive in our work as well.

These are three-day events. We use three different tools to look at gratitude, emotional intimacy, and quality-of-life issues not only for the patient with metastatic breast cancer, but for either their spouse or their support person as well. These are the things that came out of that. It really did increase their gratitude. They had a greater personal meaning of their cancer, and it did increase their emotional intimacy. I won't get into the specifics and the design of that study, but we have also seen some benefits even a couple of years later. Some very interesting themes came out of the six-week post-retreat surveys that we did.

Patients basically talked about how it changed their lives, it changed and improved their marriages, and it gave them a new unique sense of purpose. I just think that is so significant because patients going through this truly have a different experience than your early-stage breast cancer patient. That's very important for us to recognize in nursing and in clinical practices. Most of this is done in an outpatient setting, obviously. Quality of life is important as well, and their relationships with their caregivers and their support people around them are very, very important.

As I approach this conference and speaking about PARP inhibitors and PI3K inhibitors, I feel like those are things that are so important. We need to get all the knowledge across and make sure we're very consistent as the standards for treatment of metastatic breast cancer are still developing. The whole medical field is changing with the standardization of first-line and second-line treatments. These novel therapies are going to continue to be used as we have more and more of them, and as we have them around longer, we learn more about how we're using them in the indications. We've already seen that with some of the treatments that were originally studied for one thing, and now we're seeing them expanding. I know Abbey will be talking about some of those on the conference on November 12th.

Oncology Data Advisor: Fantastic, thanks so much for sharing about your work. Abbey, I think you can probably segue into your work in this area as well.

Ms. Kaler: Yes, and thank you, Janie, for the great introduction. I completely agree with Dr. Visovsky and Janie. My work really focuses on the patient who's behind this diagnosis, acknowledging that we're listening to the patient and that we are incorporating their voice at every step along the way.

For our work at MD Anderson with the Advanced Breast Cancer Program, what we're really looking at is the role of navigation and whether an Advanced Practice Nurse Practitioner Navigator is impactful on patients' quality of life, on their personalized therapy decisions, on their genomic or genetic testing, and lastly, on their goals of care. Does the role of navigation impact patients completing advanced care planning, staying out of the emergency room, and staying out of the hospital or the intensive care unit (ICU)? Lastly, are we able to use those goals of care in making our treatment decisions regarding what line of therapy is next for the patient and what medication is best? It's a really exciting time where we're looking at developing a comprehensive program to be able to support these patients.

I'm just so excited for this upcoming conference to share that news and share that excitement with our nurses. I'm excited to share that programs to support these patients do exist and that all of the wonderful work and the wonderful research that's happening is promoted so that all of our patients and all of our providers can take advantage. I'm excited to be with you all.

Oncology Data Advisor: Great, thank you. Julia, would you like to talk about your research in this field also?

Ms. LaBarbera: Yes, so for this talk, I'm going to be addressing antibody-drug conjugates—we're becoming more familiar with sacituzumab govitecan and trastuzumab deruxtecan—as well as immunotherapy, where we already have atezolizumab, but now we're seeing expanded use of pembrolizumab. All of these drugs are really changing the landscape for treatment of metastatic breast cancer, which is hugely exciting, particularly in the triple-negative space.

What I think is particularly interesting is now that we're seeing such positive results in the metastatic space, we're starting to test these drugs in the early breast cancer space. Everything we are learning about what our metastatic patients are going through will be better able to translate to our early breast cancer patients, so that we can hopefully gain some more long-term knowledge and data about these drugs in terms of how they are going to affect people long-term. As we get better at treating people with breast cancer, everyone is living longer, and these could have some potentially serious impacts on their quality of life—like chemotherapy-induced peripheral neuropathy and other yet-unknown long-term potential impacts from immunotherapy.

What we are learning is that even after immunotherapy stops, patients are still at risk for immune-related adverse effects. This is a hugely important thing for our nurses to be aware of and continue to keep in the back of their minds as they're working with our patients long-term. I think this is going to be a really great conference. I'm really excited to participate and share the knowledge of what we've been learning with these agents.

Oncology Data Advisor: We're all excited for it as well. Is there anything else that any of you would like to share about either your research or anything else ahead of ODACon?

Dr. Visovsky: I'd like to share that I recently completed a study of 17 women with metastatic breast cancer. We did some qualitative interviews with these women to find out that they're still struggling with quality of life, energy conservation, taking care of young children, employment, intimate relationships, and with financial toxicity. I think these are things that we should keep in mind as we keep working with patients, even if they're getting the novel therapies for early-stage breast cancer, that some of these problems are going to carry over.

Ms. Metsker: I want to echo on that, Connie. Especially with the novel therapies, the financial toxicity is so important because there are so many different insurances out there these days, and some cover, some don't. Just getting them approved to be paid for by a third-party provider or through the government—different types of insurance, Medicare, Medicaid—is really another whole layer that this adds for your clinic. I think that's a really good point you bring up about financial toxicities, that hopefully will come up a little bit too in the conference.

Dr. Visovsky: We'll talk at the conference also about adherence to therapy. I'm going to talk about the CDK4/6 inhibitors, but like all oral therapies, adherence is an issue. Financial issues make people do things with their medications that we may not want them to do—space them out, not refill them, etc. Then we have to think about how our novel molecularly targeted therapies work when they're not taken at 100% capacity.

Ms. Metsker: I think patient engagement is a really important piece of that. Sometimes I believe that as we are working with patients, depending upon their level of involvement with their care and their understanding, there's always that danger that they're under-reporting or not reporting side effects that are very important, because they don't want to come off treatment or have a dose reduction. There are some very important aspects to that, which we'll be addressing in the conference.

Oncology Data Advisor: Absolutely. Well, thank you all again. This has been a really fascinating conversation and it definitely sets the stage for all the topics you'll be covering at ODACon. We're looking forward to hearing more about them. For everybody listening, ODACon is Saturday, November 12, so be sure to visit i3health.com and register so you don't miss out on these discussions.

Dr. Visovsky: It was wonderful to talk to everyone. Bye-bye now.

About Dr. Visovsky, Ms. Metsker, Ms. LaBarbera, and Ms. Kaler

Constance Visovsky, PhD, RN, ACNP, FAAN, is the Director and Lewis & Leona Hughes Endowed Chair of the College of Nursing at the University of South Florida. She specializes in the treatment of patients with breast cancer, with noted expertise in the management of neurotoxic effects of chemotherapy, particularly chemotherapy-induced peripheral neuropathy. Dr. Visovsky's research interests include exercise behavior and gait and balance training for improving symptoms of neuropathy in patients receiving chemotherapy for breast cancer. She has authored or coauthored numerous peer-reviewed publications focused on nursing management of patients with cancer.

Janie Metsker, RN, BSN, CN-BN, is the Clinical Coordinator at the Koontz Center for Advanced Breast Cancer at Saint Luke's Hospital in Kansas City, Missouri. As a Nurse Navigator, Ms. Metsker provides support for patients with newly diagnosed and metastatic breast cancer throughout the course of their diagnosis, treatment, and survivorship. In addition, she coordinates two annual retreats for patients with breast cancer and their support systems.

Julia LaBarbera, MSN, RN, AGACNP-BC, is a Nurse Practitioner in Hematology/Oncology at UCLA Health in Santa Monica, California. She specializes in the treatment and care of patients with early-stage, locally advanced, and metastatic breast cancer, including hormone receptor–positive, HER2-positive, and triple-negative subtypes. Ms. LaBarbera co-manages UCLA Santa Monica's clinic-based Survivorship Program and provides various types of treatment education and coordination of resources for patients with breast cancer and their families.

Abbey Kaler, MS, APRN, FNP-C, is an Advanced Practice Registered Nurse in the Advanced Breast Cancer Program at the University of Texas MD Anderson Cancer Center, where she specializes in the treatment and care of patients with breast cancer. In addition, she is a participator and presenter in the Weekly Advanced Breast Cancer Patient Tumor Board and Educational Webinar Series, and she is Leader of the myCancerConnection and Advanced Breast Cancer Program Partnership at MD Anderson.

For More Information

Kaler A, Johnson C, Whisenant M, et al (2022). Patient voice in metastatic cancer: a conceptual analysis. Nurs Forum. [Epub ahead of print] DOI:10.1111/nuf.12811

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.